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Haines MS, Kaur S, Scarff G, Lauze M, Gerweck A, Slattery M, Oreskovic NM, Ackerman KE, Tenforde AS, Popp KL, Bouxsein ML, Miller KK, Misra M. Male Runners With Lower Energy Availability Have Impaired Skeletal Integrity Compared to Nonathletes. J Clin Endocrinol Metab 2023; 108:e1063-e1073. [PMID: 37079740 PMCID: PMC10505543 DOI: 10.1210/clinem/dgad215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/19/2022] [Accepted: 04/18/2023] [Indexed: 04/22/2023]
Abstract
CONTEXT Female athletes, particularly runners, with insufficient caloric intake for their energy expenditure [low energy availability (EA) or relative energy deficiency] are at risk for impaired skeletal integrity. Data are lacking in male runners. OBJECTIVE To determine whether male runners at risk for energy deficit have impaired bone mineral density (BMD), microarchitecture, and estimated strength. DESIGN Cross-sectional. SETTING Clinical research center. PARTICIPANTS 39 men (20 runners, 19 controls), ages 16-30 years. MAIN OUTCOME MEASURES Areal BMD (dual-energy x-ray absorptiometry); tibia and radius volumetric BMD and microarchitecture (high-resolution peripheral quantitative computed tomography); failure load (microfinite element analysis); serum testosterone, estradiol, leptin; energy availability. RESULTS Mean age (24.5 ± 3.8 y), lean mass, testosterone, and estradiol levels were similar; body mass index, percent fat mass, leptin, and lumbar spine BMD Z-score (-1.4 ± 0.8 vs -0.8 ± 0.8) lower (P < .05); and calcium intake and running mileage higher (P ≤ .01) in runners vs controls. Runners with EA CONCLUSIONS Despite weight-bearing activity, skeletal integrity is impaired in male runners with lower caloric intake relative to exercise energy expenditure, which may increase bone stress injury risk. Lower estradiol and lean mass are associated with lower tibial strength in runners.
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Affiliation(s)
- Melanie S Haines
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Snimarjot Kaur
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Geetanjali Scarff
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Meghan Lauze
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Anu Gerweck
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Meghan Slattery
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Nicolas M Oreskovic
- Harvard Medical School, Boston, MA 02115, USA
- Department of Internal Medicine and Pediatrics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Kathryn E Ackerman
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
- Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, Boston, MA 02115, USA
| | - Adam S Tenforde
- Harvard Medical School, Boston, MA 02115, USA
- Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Cambridge, MA 02129, USA
| | - Kristin L Popp
- Harvard Medical School, Boston, MA 02115, USA
- Endocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
- Department of Energy, Oak Ridge Institute for Science and Education, Oak Ridge, TN 37830, USA
| | - Mary L Bouxsein
- Harvard Medical School, Boston, MA 02115, USA
- Endocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA
| | - Karen K Miller
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Madhusmita Misra
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
- Division of Pediatric Endocrinology, Massachusetts General Hospital, Boston, MA 02114, USA
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Beckner ME, Thompson L, Radcliffe PN, Cherian R, Wilson M, Barringer N, Margolis LM, Karl JP. Sex differences in body composition and serum metabolome responses to sustained, physical training suggest enhanced fat oxidation in women compared with men. Physiol Genomics 2023; 55:235-247. [PMID: 37012051 PMCID: PMC10190831 DOI: 10.1152/physiolgenomics.00180.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/02/2023] [Accepted: 03/28/2023] [Indexed: 04/05/2023] Open
Abstract
Sex differences in energy metabolism during acute, submaximal exercise are well documented. Whether these sex differences influence metabolic and physiological responses to sustained, physically demanding activities is not well characterized. This study aimed to identify sex differences within changes in the serum metabolome in relation to changes in body composition, physical performance, and circulating markers of endocrine and metabolic status during a 17-day military training exercise. Blood was collected, and body composition and lower body power were measured before and after the training on 72 cadets (18 women). Total daily energy expenditure (TDEE) was assessed using doubly labeled water in a subset throughout. TDEE was greater in men (4,085 ± 482 kcal/d) than in women (2,982 ± 472 kcal/d, P < 0.001), but not after adjustment for dry lean mass (DLM). Men tended to lose more DLM than women (mean change [95% CI]: -0.2[-0.3, -0.1] vs. -0.0[-0.0, 0.0] kg, P = 0.063, Cohen's d = 0.50) and have greater reductions in lower body power (-244[-314, -174] vs. -130[-209, -51] W, P = 0.085, d = 0.49). Reductions in DLM and lower body power were correlated (r = 0.325, P = 0.006). Women demonstrated greater fat oxidation than men (Δfat mass/DLM: -0.20[-0.24, -0.17] vs. -0.15[-0.17, -0.13] kg, P = 0.012, d = 0.64). Metabolites within pathways of fatty acid, endocannabinoid, lysophospholipid, phosphatidylcholine, phosphatidylethanolamine, and plasmalogen metabolism increased in women relative to men. Independent of sex, changes in metabolites related to lipid metabolism were inversely associated with changes in body mass and positively associated with changes in endocrine and metabolic status. These data suggest that during sustained military training, women preferentially mobilize fat stores compared with men, which may be beneficial for mitigating loss of lean mass and lower body power.NEW & NOTEWORTHY Women preferentially mobilize fat stores compared with men in response to sustained, physically demanding military training, as evidenced by increased lipid metabolites and enhanced fat oxidation, which may be beneficial for mitigating loss of lean mass and lower body power.
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Affiliation(s)
- Meaghan E Beckner
- U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, United States
| | - Lauren Thompson
- U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States
| | - Patrick N Radcliffe
- U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, United States
| | - Rebecca Cherian
- U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States
| | - Marques Wilson
- U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States
| | - Nicholas Barringer
- Medical Center of Excellence, Joint Base San Antonio-Fort Sam Houston, Texas, United States
| | - Lee M Margolis
- U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States
| | - J Philip Karl
- U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States
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